Rheumatoid arthritis is a common disorder. Its various articular and extra-articular manifestations are well described, but less well known is the association between rheumatoid arthritis and malignancy. There is an intrinsic risk of lymphoma, particularly non-Hodgkin's lymphoma, in rheumatoid arthritis. In determining causality, it is difficult to separate the effects of treatment from those of the disease itself — most patients with rheumatoid arthritis are treated with more than one immunosuppressive agent during the course of their disease. Cyclosporin has been implicated in the development of lymphoma, predominantly in association with transplantation.1,2 In addition, there are an increasing number of reports of B-cell lymphomas in rheumatoid arthritis patients that would seem to implicate methotrexate.3-10
- 1. Cockburn ITR, Krupp P. The risk of neoplasms in patients treated with cyclosporine A. J Autoimmunity 1989; 2: 723-731.
- 2. Penn I. Cancers following cyclosporine therapy. Transplantation 1987; 43: 32-35.
- 3. MacFarlane GJ, Black RJ. Rheumatoid arthritis and lymphatic cancer. Eur J Cancer 1996; 32A: 1630-1632.
- 4. Gridley G, McLaughlin JK, Ekbom A, et al. Incidence of cancer among patients with rheumatoid arthritis. J Natl Cancer Inst 1993; 85: 307-311.
- 5. Baecklund E, Ekbom A, Sparen P, et al. Disease activity and risk of lymphoma in patients with rheumatoid arthritis: nested case-control study. BMJ 1998; 317: 180-181.
- 6. Georgescu L, Paget SA. Lymphoma in patients with rheumatoid arthritis. What is the evidence of a link with methotrexate? Drug Safety 1999; 20: 475-487.
- 7. Georgescu L, Quinn GC, Schwartzman S, Paget SA. Lymphoma in patients with rheumatoid arthritis: association with the disease state or methotrexate treatment. Semin Arthritis Rheum 1997; 26: 794-804.
- 8. Kono H, Inokuma S, Matsuzaki Y, et al. Two cases of methotrexate induced lymphomas in rheumatoid arthritis: an association with increased serum IgE. J Rheumatol 1999; 26: 2249-2253.
- 9. Ferraccioli GF, Casatta L, Bartoli E, et al. Epstein–Barr virus-associated Hodgkin's lymphoma in a rheumatoid arthritis patient treated with methotrexate and cyclosporin A. Arthritis Rheum 1995; 38: 867-868.
- 10. Kremer JM. Is methotrexate oncogenic in patients with rheumatoid arthritis? Semin Arthritis Rheum 1997; 26: 785-787.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.